If yes, describe what comes out, frequency, and how long has it been going on.

Any change in: (Please check all that apply)*

Thirst

Appetite

Urination frequency

Urination amount

Blood in urine

Energy level

Diet

If yes, describe .

Is your pet experiencing any pain?*

Yes

No

If yes, please describe pain.

Is your pet currently on any medications? Please provide name, amount given, frequency given, and strength of each medication.*

There will be an office call charge and hospitalization fee, along with any other fees for other services performed. We will try and contact you BEFORE performing any services beyond the exam, unless it is imperative for the pet's health and safety (in which case we may not wait to contact you and you will still be responsible for those charges and fees).

*

Please call me before performing any tests or treatments to my pet.

You have my permission to perform laboratory testing ($100 and up), X-rays (1 - $95 / 2 - $180) or other tests needed and to treat my pet as deemed necessary by the veterinarian.